Key result
High APN, AQP4, and BDNF levels linked to substantially lower perioperative neurocognitive dysfunction risk.
Why the study?
Perioperative neurocognitive disorder frequently complicates thoracic surgery with poor outcomes and limited late treatments, making reliable biomarkers for early diagnosis essential.
Do serum levels of APN, cAMP, PKA, AQP4, and BDNF predict perioperative neurocognitive disorder in elderly patients undergoing thoracic surgery?
Do serum levels of APN, cAMP, PKA, AQP4, and BDNF predict perioperative neurocognitive disorder in elderly patients undergoing thoracic surgery?
High postoperative serum levels of APN, AQP4, and BDNF are independent protective factors against perioperative neurocognitive disorder in elderly patients undergoing thoracic surgery, and their combination offers strong predictive value.
May support preoperative risk stratification in elderly thoracic surgery patients; hypothesis-generating pending larger prospective validation.
Perioperative neurocognitive disorder (PND) is a common complication following thoracic surgery and often leading to poor outcomes. Despite ongoing research, effective treatments for late PND remain limited. Identifying reliable biomarkers for early diagnosis is, therefore, essential. A prospective cohort study was conducted with 60 elderly patients undergoing thoracic surgery. Serum samples were collected within 10 minutes prior to anesthesia and following extubation to measure adiponectin (APN), cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), aquaporin-4 (AQP4) and brain-derived neurotrophic factor (BDNF). Among PND patients, serum APN, PKA, AQP4, and BDNF levels were markedly decreased compared with the normal group. While serum cAMP (HR = 1.087, p = 0.695, 95% CI [0.284-4.166]) and PKA (HR = 0.996, p = 0.09, 95% CI [0.491-0.947]) were not significantly correlated with PND, serum APN (HR = 0.307, 95% CI [0.113-0.835], p = 0.021), AQP4 (HR = 0.204, 95% CI [0.060-0.697], p = 0.011), and BDNF (HR = 0.382, 95% CI [0.177-0.823], p = 0.014) were protective factors against PND. ROC analysis demonstrated that APN (AUC = 0.68, 95% CI [0.51-0.87]), AQP4 (AUC = 0.73, 95% CI [0.59-0.87]), BDNF (AUC = 0.73, 95% CI [0.59-0.87]), and the model of combining those biomarkers (AUC = 0.91, 95% CI [0.83-0.99]) could predict PND. PND patients exhibited a lower protective stress response to surgical trauma. High serum APN, AQP4, and BDNF levels were independent protective factors for PND, and a combined model of these biomarkers showed predictive potential for PND.
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Zhang et al. (2025) studied this question. High serum levels of APN (HR 0.307), AQP4 (HR 0.204), and BDNF (HR 0.382) are independent protective factors against perioperative neurocognitive dysfunction in elderly patients.
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